Uterine sarcoma. Clinico-pathological characteristics and outcome

To investigate the clinical and histopathological characteristics, with the prognostic factors, treatment outcome, pattern of relapse, and survival analysis of uterine sarcoma patients. All patients with histologically proven uterine sarcoma were identified using the database at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2000 and December 2012. A total of 36 patients with uterine sarcoma were reviewed. The median age of all patients was 57 years, and the mean age was 57.72 +/- 13.17 years. Carcinosarcoma was reported in 21 patients [58%], leiomyosarcoma in 7 [19%], undifferentiated endometrial sarcoma in 6 [17%], and rhabdomyosarcoma in 2 [6%]. Approximately half of the patients were stages III and IV [28% and 25%], while 15 patients [41%] were stage I; only 2 patients [6%] were stage II. The surgical treatment was hysterectomy and bilateral salpingoophorectomy [H+BSO] plus staging in 18 patients [50%], while in 4 patients [19%], H+BSO plus debulking was performed. Adjuvant chemotherapy was given in 24 [69%] and adjuvant radiotherapy in 5 [14%] cases, At a median follow-up period of 13.5 months, 8 patients [22%] relapsed. The 2-year disease-free survival [DFS] rate was 22% and the 5-year was 14%. In the multivariate analysis, the advanced stages [p=0.015] and lymph vascular invasion [p=0.0001] were associated with poor DFS, while the use of chemotherapy significantly improved the DFS [p=0.027]. The poor outcome of high-grade uterine sarcoma patients was identified, and only one third of patients [30%] survived for 2 years. This finding necessitates the need for more aggressive tools to fight this disease

Conservative treatment of ovarian cancer, Safety, ovarian function preservation, reproductive ability, and emotional attitude of the patients in Saudi Arabia

To evaluate the safety, ovarian function preservation, reproductive ability, and the emotional attitude after a conservative surgery for ovarian cancer. This is a retrospective study of women conservatively treated for primary ovarian cancer between January 2000 and December 2010 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Patient's charts were reviewed for pathology, stage, requirement of adjuvant chemotherapy, and recurrent, as well as menstrual history, and pregnancy after treatment. During follow up the patients were asked 3 questions about their emotional attitude toward their disease. There were 39 patients identified [mean age 22 years]. Thirty-one [80%] patients were presented with stage I and 20 [52%] were Germ cell tumor. Fifteen [39%] patients received initial chemotherapy after primary surgery. Three [8%] patients had recurrent. Thirty-eight [98%] patients retuned to a regular menstruation after treatment. Eight patients [20%] had a normal pregnancy. Of the respondents to the given questions, 10 [44%] patients claimed that their disease did not have any impact on their desire to have children and 12 patients [52%] feared that their ovarian disease could have damage in their reproductive potential. Only 9 patients [39%] had no concerned about the effect of the treatment they received on the offspring. Fertility sparing surgery in ovarian cancer appears to be safe, and a practical treatment option in selected cases with ovarian cancer diagnosis. Most patients can have ovarian preservation after treatment and should not be discouraged from getting pregnant

Knowledge, attitudes, and practices regarding cervical cancer screening among physicians in the Western Region of Saudi Arabia

To evaluate knowledge and practice of the Pap test, the role of HPV in the etiology of cervical cancer, and attitudes regarding the HPV vaccine of female physicians in the Western Region of Saudi Arabia. A cross-sectional descriptive study using an interview with a structured questionnaire to obtain information regarding cervical cancer, practice in screening for cervical cancer, and attitudes of female physicians regarding the HPV vaccine in different health facilities in Saudi Arabia. The study was performed in the Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, between May and December 2009. Of the 200 respondents, 70 [35%] physicians comprised gynecological doctors [GDs] group I, and 130 [65%] physicians comprised the non-gynecological doctors [NGDs] group II. The mean age was 36 years. A total of 63 [90%] in group I, and 87 [60.5%] in group II knew that HPV is a cause for cervical cancer. Forty-five [64.3%] in group I, and 44 [33.8%] in group II believed that cervical cancer was curable [p<0.05]. A total of 182 [91%] physicians in the GDs and NGDs group knew that the Pap smear test is used as a screening method for cervical cancer. A total of 97 [48.5%] physicians knew about the HPV vaccine. When the physicians were provided with information regarding the HPV vaccine, 100 [50%] physicians stated they would recommend the vaccine to their patients. Physicians in Saudi Arabia would benefit from further education regarding the available screening, prevention for HPV, and cervical cancer

Attitudes, knowledge, and practices in relation to cervical cancer and its screening among women in Saudi Arabia

To assess the knowledge, attitude, and practices related to cervical cancer screening, and its underlying etiology and preventive measures among women living in the Kingdom of Saudi Arabia. Six hundred self-administered questionnaires were distributed to randomly selected women from different groups in the general population of Jeddah, Kingdom of Saudi Arabia. These questionnaires were sent out to school teachers, relative, friends, as well as, through direct interview of patients visiting the outpatient clinic while awaiting for their appointments at the King Abdul-Aziz University Hospital from January to March 2008. There were 500 respondents [83.3%]. The knowledge of the human papilloma virus [HPV] as an etiological agent for cervical cancer was expressed by 72 [14.4%], and the HPV vaccine by 49 [9.8%] of the respondents. Whereas, 338 [67.6%] of the respondents were aware of the Pap smear, however, only 84 [16.8%] had undergone the test. The main reason for not having a Pap smear was the lack of awareness. The awareness on cervical cancer among women in Saudi Arabia is far behind that in the developed countries. There is a need to educate and promote awareness of cervical cancer in this population

Primitive neuroectodermal tumor of the ovary

A 31-year-old woman presented to King Abdulaziz University Hospital complaining of an abdominal pain and a rapid increase in abdominal girth. An ultrasound and MRI, revealed a huge cystic ovarian mass without ascites. Ovarian tumor markers were all within normal range. Exploratory laparotomy showed huge right ovarian mass with omental mass. Frozen section from the omentum showed metastatic malignant neoplasm. Total abdominal hysterectomy was carried out with bilateral salpingooophorectomy and omentectomy with residual tumor of less then one centimeter. Final pathology assessment showed primitive neuroectodermal tumor arising from the right ovary. She received post- operative chemotherapy. Four months later she had recurrence and was given second line chemotherapy, but she did not respond and died 15 months after the diagnosis due to obstructive uropathy

Ovarian mucinous cystadenoma in a female with Turner syndrome

The development of an epithelial tumor, especially mucinous type, in a female with a streak gonad is rare and not fully understood. We report a case of a 19-year-old; a single female known to have Turner syndrome presented with an increased abdominal girth and was found to have a huge pelvic and abdominal mass. Ultrasound and magnetic resonance imaging revealed a huge cystic ovarian mass with no ascites. Laparotomy and right oophorectomy were performed for the ovarian mass. Histology revealed a large mucinous cyst adenoma. Further study of these tumors may help to eludicate the underlying cause and pathogenesis

Outcome of patients with early stage epithelial ovarian cancer treated with no adjuvant therapy

To determine the clinical outcome of women with surgical stage I epithelial ovarian cancer [EOC] treated with surgery alone. A retrospective chart review of early stage ovarian cancer patients between 1984 and 1997 was performed using the Alberta Cancer Registry data base. From this 75 women were identified with stage I EOC following comprehensive surgical staging with no further post operative therapy. Data extraction included demographics. Prognostic factors recurrence events and survival. only patients with invasive, fully staged Stage I EOC without any adjuvant therapy were included in this is analysis. Data was collected and entered using Excel and statistical analysis was done using S-Plus software. 75 patients with fully staged Stage I EOC were grouped according to presence or absence of risk factors. Group I-32 patients [42.7%] had no risk factors. [Stage Ia, lb G1andG2], Group II-43 patients [57.3%] had risk factors, including 18 patients with clear cell type, 16 patients with cyst rupture, 3 patients with ovarian capsular involvement and 6 patients with Grade 3 histology. Median age for the entire group was 49 years [19-81]. Median follow-up 48 8 months [3.1-1699]. Recurrent disease was noted in 4 women in group I [12.5%], and 4 women in Group II [9.3%] for an overall recurrence rate of 10.7% [95% CI 4, 7-19.9%]. In Group ii, there were 2 recurrences each in women with clear cell cancer type and higher grade cyst rupture. There was no statistical difference in recurrence free survival [p value =0.97] and overall survival [p value=0.537] between groups I and II. The 3 year disease free survival and overall survival was 91 4% [95% C.I:85.1 98 2% and 959% 195% C.I: 91 100%] in all patients respectively. An optimal surgical staging procedure is required to correctly diagnose those patients with Stage I EOC. In this series patients with early Stage I EOC after comprehensive surgical staging had excellent outcome despite no adjuvant therapy. It is suggested that patients with grade III tumors non-clear cell type, cyst rupture and capsular involvement may be observed with no adjuvant postoperative therapy, but a randomized trial is needed to confirm this hypothesis

Uterine lipoma

Pure lipoma of the uterus is a rare entity and few cases have been reported. They usually develop in postmenopausal women. Clinical symptoms and physical signs are similar to those found in leiomyomas. The histogenesis of these lesions is still unclear. The diagnosis is easily made at the time of surgery or at autopsy, but before this, they may lead to many problems in the differential diagnosis with another uterine tumors. Recent papers suggest the possibility of a preoperative diagnosis made by computed tomography and magnetic resonance imaging. We report a case of a 67-year-old postmenopausal women presented with pelvic pressure and urinary symptoms. Pathological evaluation revealed pure intramural lipoma of the uterus illustrating characteristic morphological and histological findings with no evidence of sarcomata's component